I was at a presentation last night given by a genetic neurobiologist who is also a psychiatrist. I think he’s got a very good reputation in his field. He’s been looking at the genetic links to mental illness. They’ve discovered that a huge list of mental illnesses are related, including ADD, anorexia, anxiety, bipolar disorder, OCD, unipolar depression, schizophrenia and several others that I don’t remember, as well.
Bipolar disorder is related to at least 22 genes, and changes in specific alleles on those genes. By comparison, a congenital eye disease that results in blindness is related to just 5 genes. He had been looking at the sequence of one allele, and discovered that in people with a wide variety of mental illnesses, portions of that allele were transposed from the position they are in normal people.
This is interesting, because it suggests that a wide variety of mental illnesses may stem from similar genetic predispositions, and perhaps the expression of that predisposition is related to differing environmental conditions. That is purely speculative, since they still have little idea how this works. They do know that, for this particular allele, it changes the protein that regulates how sodium and potassium chains enter into nerve cells in the brain.
More and more, it appears that mental illness is primarily of organic origin. Once they figure out which genes are involved and which proteins they express, they’ll be able to design a diagnostic test first, and later on, drugs that are designed specifically to counteract the negative effects of the protein in our brains. He thinks this will happen in ten to twenty years.
There are a number of questions this research brings up. First: is the distinction that is made in the DSM IV between these various mental illnesses justified by these genetic indicators? Perhaps they are just different expressions of pretty much the same thing? Those of us who suffer from these things know that a lot of the same drugs are used to treat all of them.
Second, are the other alleles that create a predisposition for these conditions similar, or different? Third, how the hell do these proteins work inside our brains—how do they change our capability for thoughts of specific kinds?
I wanted also to make sure that people know that a genetic predisposition for something does not mean a person will get that disorder. It also requires an environmental stressor to kick in. The primary environmental stressor is alcohol or drugs. However one of the other stressors is steroids. Interestingly, when we are under stress, our brains create more of a natural steroid—cortisol. So it is possible that this is one way the genes are expressed.
Other questions: once the genes kick in, can they kick out again, and go back to creating the normal protein? If cortisol is a response to environmental stress, then does therapy help people respond to environmental stresses more effectively, thus reducing cortisol levels, and letting the disorder “kick out?”
If these things are found to be true, then what is the appropriate order of treatments? Drugs, then therapy, or therapy, then drugs? In physical medicine, if you break a bone or something, you first get the bone fixed, and then you enter into physical therapy.
In all of this, as @rooeytoo points out, the specialty of the medical practitioner may influence their predilection towards a treatment. Psychiatrists might prefer to start with meds. Psychologists might prefer to start with therapy. Osteopaths might prefer to start with an operation. GPs might prefer to start with physical therapy. The point is that it can be useful to get a second opinion, perhaps from someone with a different specialty, on the best course of treatment. Of course, if you get two different opinions, then what do you do?
Finally, I want to express my amazement at all of this. It is comforting to know that the way I behave (or misbehave) is the result of having different proteins in my brain than most people have. It means that, if I choose to, I can take drugs to make my brain work more like most people’s brains. Of course, the opposite is true, too. Normal people could take drugs to make their brains behave as mine does, should they need to do that on occasion. Just as athletes take steroids to build muscles faster and stronger, ordinary people might take drugs to have their minds work faster and more creatively.
While anxiety and depression and self-starvation can kill us, there may be beneficial sides to these things, as well. I have found that, if managed properly, someone with ADD or OCD can do excellent and productive work. I’ll bet that there are conditions under which my mood swings could be managed so that I could have bursts of activity that are extremely productive, interspersed by periods of time when I can’t do shit. There must be jobs where this would be very useful. So we may not only have one option: medication. If society were to change a bit, we could provide safe places where “abnormal” people could become very productive and useful members of society.